Healthcare Sanctions – It’s Good to Have Options

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Newsflash! We understand that those in the healthcare (and other industries) are required to conduct pre-employment background checks as part of their hiring process and that the background screening industry is asked to perform these checks from time to time. Not impressed with this revelation? Fair enough, but let’s talk about something that might be a pleasant surprise for Consumer Reporting Agencies (CRAs) and their healthcare and other regulated customers. Complying with requirements to conduct a proper sanctions search has become more competitive and more transparent.

First the Back Story

For years, it seemed that Fraud Abuse Control Information System (FACIS) was the only game in town, and for good reason. There weren’t many other options, if any, and Verisys did a great job with making the brand name synonymous with a healthcare sanctions check.  That’s no small accomplishment. Often times, we’d meet with our healthcare clients and they would specifically ask for FACIS as opposed to a medical sanctions search. Many didn’t know whether they needed a Level 1, 2 or 3 search but they knew if they got a FACIS search, it was good for them.

Now, we certainly don’t have anything against the FACIS search, but there were a couple things that concerned us over the years. First, when we would press Verisys on the specifics of their search, they weren’t so forthcoming when it came to their data sources. For example, we didn’t know if the data was primary sourced, how often that data was updated and the process for ensuring accuracy. From time to time, this left us in a less than favorable position with our clients when we couldn’t properly answer their questions about what was and was not covered in their search or why a particular search didn’t reveal something they thought it should. Further, it was never pleasant to visit with our customers that we were selling FACIS searches to only to find out that Verisys attempted to sell them direct while we were working with them. Those were fun conversations. And lastly, since they were practically the only game in town, the cost was a take it or leave it proposition.

Competition is Great for Everyone

One of the positive new developments we’ve seen over the last year is the emergence of quality alternatives when it comes to medical sanctions searches by reliable providers that the industry have come to know and respect. Both Innovative and SJV now offer searches that comply with state and federal guidance. And of course it’s comforting to know that neither are in direct competition with retail CRA’s.

Innovative’s I-MED sanctions and exclusions product offers Level 1, 2, and 3 solutions and features more than 1,700 direct primary sources. covering healthcare sanctions, exclusions, debarments and board actions from all 50 states and a number of U.S. territories. They also provide fully disclosed source lists.

SJV also offers primary sourced data with their MedEx product and boasts that their solution meets or exceeds the best practice requirements for screening excluded parties detailed in the “Special Advisory Bulletin on the Effect of Exclusions from Participation in Federal Health Care Programs,” issued May 8, 2013.

We actually reviewed that aforementioned advisory which covers a wide range of topics on how individuals should be screened and there’s no mention at the state or federal level of a required brand.

This is good news for the industry and the clients you serve. It means that you have choices when it comes to serving the healthcare industry. While we don’t know how SJV and Innovative price their products, we do know that competition fuels innovation, transparency, quality and yes, price. So, while there is nothing wrong with FACIS, it’s good to know that you have options.

While we can’t tell you which option is right for you and your clients, it’s good to know that you have a choice; no different than the type of choice you have when deciding which court researcher, criminal record database, social security number trace or credit report to offer. Just like these other solutions, each will have their pros and cons, but you no longer have to feel like you have no choice in the matter.

May the best company win.

By Nick Fishman and Jason Morris

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